Product Configuration Quality Analyst

What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!Reporting to the Product System Configuration Supervisor, the Product Configuration Quality Analyst is responsible for ensuring the integrity of all claims system configuration created and maintained by the Product System Configuration team. The Product Configuration Quality Analyst audits claims system configured by the Application Architects and Analysts to ensure accurate adjudication of claims. Ensure all Business Rules are configured correctly in the claims system. Support testing efforts within an agile team and execute all levels of testing (System, Data validation, Integration and Regression). The Product Configuration Quality Analyst utilizes quality auditing tools, identifies trainings needs, and collaborates on effective and efficient methods for accurate and quality system configuration.Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.PerksIEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.Competitive salaryState of the art fitness center on-siteMedical Insurance with Dental and VisionLife, short-term, and long-term disability optionsCareer advancement opportunities and professional developmentWellness programs that promote a healthy work-life balanceFlexible Spending Account – Health Care/ChildcareCalPERS retirement457(b) option with a contribution matchPaid life insurance for employeesPet care insuranceEducation & RequirementsThree (3) years of experience of auditing complex system configuration requiredThree (3) years of experience in Managed Care requiredExperience with claims review requiredExperience in claims analysis/auditing preferredExperience in major managed care system migration/implementation preferredBachelor’s degree in IT or Business from an accredited institution requiredIn lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required for this position: one (1) year of general healthcare experience plus three (3) years of claims analysis experience is requiredThis experience is in addition to the minimum years listed in the Experience Requirements aboveKey QualificationsComprehensive knowledge and understanding of:Regulatory compliance and how configuration changes affect regulatory adherenceCPT, HCPCS, Revenue, ICD-10 Coding rules and guidelinesGeneral managed care operations and delegated plan modelsCMS, DHCS, DMHC, NCQA rules and regulationsEncounters, EDI submissions, provider web portals, integrated NCCI applications, and overall data mappingSystem and application process integrations and algorithmsMedicare, Medi-Cal, and Covered California benefit structure and regulatory billing guidelinesMedicare, Medi-Cal, and Covered California claim processing guidelinesRelational database structureTesting and audit methodologiesStrong skills in performing independent root cause analysis, developing test cases, and documenting findingsSkills in Microsoft Excel, Access, and SQL applicationsExceptional problem solving and critical thinking skillsStrong presentation and written communication skillsAbility to interpret regulatory changes and assess the need for configuration updatesAbility to identify training gaps and advise leadership on quality trendsProven ability to:Operate as an independent reviewer and provide objective assessments under tight schedulesWork independently and solve complex problems with little to no assistanceEffectively manage competing prioritiesEnsure compliance and quality assurance standards are metSchedule may adjust based on business need which may include evenings, holidays, and weekends to ensure completion of projects and to meet deadlinesStart your journey towards a thriving future with IEHP and apply TODAY!Pay Range$80,059.20 USD Annually - $106,059.20 USD Annually